Cathartics hypodermatically / by E.S. M'Kee.

  • McKee, Edward S.
Date:
1908
Catalogue details

Licence: In copyright

Credit: Cathartics hypodermatically / by E.S. M'Kee. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    [Reprinted from The Lancet-Clinic, January 18, 1908.] * ft CATHARTICS HYPODERMATICALLY.* BY E. S. M’KEE, M.D., CINCINNATI. Podophyllin may be taken as an example of a group of vegetable cathartics, solutions of which, either introduced under the skin or intravenously, occasion increased peristalsis. Podwissotsky has found two active principles in podophyllin—a neutral crystalline substance known as podophyllotoxin (G/3H21O9) and pi- cropodophyllin. The official resin of podo- phyllin consists of two resins, one soluble in both ether and alcohol, the other in alcohol alone. Squibb describes podophyllotoxin as a yellowish-white, very bitter powder, solu- ble in alcohol, partially in ether and chloro- form, drastic cathartic. Dose by the mouth, one-twelfth to one-eighth grain (0.005 to 0.008 gm.) in alcoholic solution. Podophyl- lotoxin injected under the skin of an animal or man causes a purgation in from twenty minutes to an hour. The injection of one- fifth grain under the skin of a terrier pro- duced seven liquid stools within three hours. Podophyllotoxin injected under the skin of a cat and the cat killed a few hours later, the gut from near the stomach to the large intestine shows marked congestion. If the mucous membrane and contents of this por- tion be extracted with alcohol a solution is obtained which possesses the properties of podophyllotoxin. The local irritation of this drug, when used subcutaneously, is such that it cannot be used indiscriminately. This ob- jection holds with solutions of the other veg- etable cathartics which act when used hypo- dermatically, such as aloes, senna and colo- cynth. Salicylate of eserine has been studied by Craig, of Boston, and Vineberg, of Mt. Sinai Hospital, New York. They used it in milligramme doses hypodermically every three hours, producing catharsis in 50 to 75 per cent, of cases. It acts on the muscular coat of the intestine like ergot on the muscles of the uterus. It does not pour out fluids into the intestine. It will not act if the mus- cles of the intestines are so distended with gas that they are paralyzed, Mackenzie and Dixon (Edinburgh Medical Journal, November, 1898), report numbers of experiments with podophyllotoxin hypo- dermically in cats, dogs and men, resulting in copious evacuations in about one-half hour. Atropine has been known to produce peri- stalsis in some cases when used hypodermi- cally. It is not likely to come into favor because of its other action on the secretory glands. THE MORPHINE GROUP. Morphine injected in large doses induces purgation and vomiting in some cases. Apo- morphine is a powerful emetic, but has little effect on the intestine. Codeine produces purging in animals more readily than mor- phine, whilst apocodeine brings on purging without any vomiting. APOCODEINE HYDROCHLORIDE. Guinard showed first that vomiting did not follow its use, as in the case of apomorphine. Murrell experimented with it and discovered that it was of value as an expectorant. Ro- viart used it subcutaneously in patients suffer- ing from constipation, and reported in its favor. Two c.c. of a 1 percent, solution of apocodeine (about 3/s grain), injected under the skin of a man produced one or two soft motions in an hour. There is no feeling of nausea, and a slight irritation at the seat of the injection passes off in a short time. Ex- periments on animals go to show that apo- codeine acts diametrically opposite to nico- tine—that is, it causes vaso-motor dilatation, fall of blood-pressure, increased peristaltic movements. The absence of effect on the stomach by apocodeine may be explained by Read before the First Councilor District Medical Society, Cincinnati, December 9, 1907.